Provider Demographics
NPI:1053306092
Name:KIMMEL, DAVID PAUL (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:PAUL
Last Name:KIMMEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1568
Mailing Address - Street 2:
Mailing Address - City:BANNER ELK
Mailing Address - State:NC
Mailing Address - Zip Code:28604-1568
Mailing Address - Country:US
Mailing Address - Phone:828-898-5177
Mailing Address - Fax:828-898-8306
Practice Address - Street 1:150 PARK AVE
Practice Address - Street 2:
Practice Address - City:BANNER ELK
Practice Address - State:NC
Practice Address - Zip Code:28604-6604
Practice Address - Country:US
Practice Address - Phone:828-898-5177
Practice Address - Fax:828-898-8306
Is Sole Proprietor?:No
Enumeration Date:2005-09-15
Last Update Date:2011-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC31158207R00000X
TNMD25106207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC110035534OtherRAILROAD MEDICARE
NC48974OtherNC BLUECROSSBLUESHIELD
TN3004186OtherTN BLUECROSS & TENNCARE
NC8948974Medicaid
TN4183673Medicaid
NC48974OtherNC BLUECROSSBLUESHIELD
TN3885952Medicare ID - Type Unspecified
TN4183673Medicaid